Take a Break: Enjoy Morning Light

As we head into fall, take sometime to really enjoy the first light of the morning. Go outside, for as long as you can, and savor the light between 6:30 and 9 AM, which seems to have the most benefit. Don’t stare at the sun though, which is not only bad for your eyes, but it will make you squint. Because mood and facial muscles are linked, if you squint, it signals your brain that you are irritated. So wear some sunglasses and bask in the glow. 

Great time to enjoy a “cuppa,” as the Brits say, of something soothing/enjoyable-tea, coffee, juice. Whatever strikes your fancy.

Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Life With Chronic Disease: A Happy Life

 Being sick for most of his life, it didn’t keep Sam Berns from having a happy life. His approach to dealing with long term chronic illness was very straightforward:

• I’m okay with what I ultimately can’t do because there is so much I can do.

• I surround myself with people I want to be with, people of high quality.

• Keep moving forward. I always try to have something to look forward to. Something to strive for to make my life richer. It doesn’t have to be big.

• I try hard not to waste energy feeling badly for myself, because when I do, I get stuck in a paradox, where there’s no room for any happiness or any other emotion. It’s not that I ignore when I’m feeling badly, I kind of accept it, I let it in, so that I can acknowledge it, and do what I need to do to move past it.

• Never miss a party if you can help it.

Watch Sam's TED Talk. Hard to believe he had this much wisdom as a 17 year old. 

Take a Break: Play with Fractals

 Fractals are repeated similar or identical patters, which can be found in nature, art, architecture etc. A never-ending pattern, a good example is a tree. First you see the big branches growing out of the trunk. Then you see smaller versions growing out of each big branch. As you keep zooming in, finer and finer branches appear, all the way down to the smallest twigs.  Read more

 Looking at fractals is a great way to relieve stress. Some examples of fractals in nature-ocean waves, snowflakes, flowers, leaves, mountains. Mandalas are an example from the art world as are quilts

• Watch the clouds and notice patterns

• Take a walk in nature

• Visit a garden

• Blow bubbles. Don’t have bubble stuff on hand? Mix 2 cups warm water, 1/3 cup dish soap and ¼ cup corn syrup. No bubble wand? Check out a variety of options at Homemade bubble wands.

• Play with a fractal online (this is mesmerizing) 

• Make a Fractal 

• Design a Fractal  

Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Journal Watch August 2017

CHRONIC PAIN

• Tuning out arthritis pain with radio energy:A noninvasive treatment for knee arthritis has been developed that uses cooled radio energy to target and interrupt pain signals.  Known as “Coolief,” the procedure can provide several months of relief from chronic arthritis pain for patients for whom surgery is not an option. Science Daily

• Study Finds Options to Opioid Use After Knee Surgery: Alternative drug-free interventions to manage pain, including acupuncture and electrotherapy, may help reduce the need for prescription painkillers after knee replacement surgery, a new review suggests. The finding stems from an in-depth look at 39 already-completed studies. These studies included nearly 2,400 total knee replacement patients. JAMA Surgery

• Marijuana May Help Ease Nerve Pain: Marijuana may be slightly effective at reducing chronic nerve pain known as neuropathy. But there's little evidence on whether or not pot helps treat other types of pain or post-traumatic stress disorder (PTSD), a pair of new studies suggests. The findings on neuropathy "fit generally well with what we know," said Dr. Sachin Patel of the Vanderbilt Psychiatric Hospital in Nashville. Patel wrote a commentary accompanying the review in the Aug. 15 online edition of Annals of Internal Medicine.

• To reduce postoperative pain, consider sleep -- and caffeine: A new preclinical study found that a brief period of extended wakefulness before surgery enhances pain and prolongs recovery time after surgery. Caffeine administration helped to reduce the harmful effects of sleep loss on subsequent surgical pain. Sleep

• Contraceptive pill linked to lowered risk of rheumatoid arthritis: But no such association found for breastfeeding after influential factors accounted for. Taking the contraceptive pill, particularly for seven or more consecutive years, is linked to a lowered risk of developing rheumatoid arthritis. BMJ

• Early rotator cuff surgery yields good long-term outcomes: Early surgery to repair tears of one of the shoulder rotator cuff muscles provides lasting improvement in strength, function, and other outcomes, reports a study. The Journal of Bone and Joint Surgery

• Evidence does not support the use of gabapentinoids for chronic low back pain: Existing evidence on the use of gabapentinoids in chronic low back pain (CLBP) is limited, and demonstrates significant risk of adverse effects with no benefits on pain relief, according to a recent meta-analysis. PLOS Medicine

 COMPLEMENTARY & ALTERNATIVE MEDICINE

• Yoga helps back pain among veterans: Trial among first to show effectiveness of yoga specifically in military veterans. Those who completed a 12-week yoga program had better scores on a disability questionnaire, improved pain intensity scores, and a decline in opioid use, a study that included 150 veterans with chronic low back pain found. The findings jibe with those from two past clinical trials involving non-veterans. American Journal of Preventive Medicine

• Yoga effective at reducing symptoms of depression: A multi-week regimen may be an effective complement to traditional therapy for depression, multiple studies suggest. American Psychological Association

• As Many as 1 in 3 Experience New or Worse Pain with Yoga: Many people try yoga hoping to heal an injury, but some wind up with more aches and pains, a new study finds.

The study, which surveyed hundreds of people doing yoga for more than a year, found that two-thirds said that some existing aches improved because of yoga -- most often, lower back and neck pain. On the other hand, 21 percent said yoga worsened their muscle or joint pain. And almost 11 percent said it caused new issues -- most commonly, pain in the hand, wrist, elbow or shoulder. Journal of Bodywork & Movement Therapies

• Guided self-help approach to graded exercise program is safe, may reduce fatigue for patients with chronic fatigue syndrome: A self-help approach to a graded exercise program, supervised by a specialist physiotherapist, is safe and may reduce fatigue for some people with chronic fatigue syndrome (CFS), according to a new trial of 200 people. The self-help intervention (guided graded exercise self-help, or GES) involves slowly and safely building up physical activity levels (eg. a few minutes walking) after establishing a daily routine, with the support of a specialist physiotherapist over the phone or Skype(tm).The Lancet

• Music therapy helps people with Parkinson's build strength through song: A music therapy class is helping people with Parkinson's disease build strength through song. A new study shows singing improves the muscles used for swallowing and respiratory control -- two functions complicated by Parkinson's. Complementary Therapies in Medicine

• Resistance training may slow down the progression of multiple sclerosis: New research shows that resistance training protects the brain in persons with multiple sclerosis, which may delay the development of the disease. In the past, multiple sclerosis patients were advised not to exercise for fear of exacerbating the illness. However, it is now known that physical training can relieve many of the symptoms, including the excessive fatigue and mobility impairments that are often seen. New research now shows that resistance training may protect the nervous system and thus slow the progression of the disease. Multiple Sclerosis Journal

ª Marijuana associated with three-fold risk of death from hypertension: Marijuana use is associated with a three-fold risk of death from hypertension, according to new research. European Journal of Preventive Cardiology

• Marijuana Alters Levels of Seizure Drug: Scientists experimenting with the marijuana compound cannabidiol as an epilepsy treatment must evaluate any interactions with other anti-seizure drugs patients are taking, researchers report. The new research from the University of Alabama at Birmingham suggests cannabidiol affects blood levels of several anti-seizure drugs, especially clobazam. Epilepsia

• Opting for CAM over Conventional Therapy is Risky for Cancer Survival: Patients who opted for alternative medicine as the sole treatment for potentially curable cancers had significantly worse survival compared with similar patients who received conventional therapy, a retrospective comparison showed. Overall, reliance on alternative medicine more than doubled the survival hazard, which increased as much as five- or sixfold, depending on the type of cancer. Patients who opted for alternative strategies tended to be younger, healthier, and more affluent as compared with patients who received conventional care for their cancers. The study did not include patients who received complementary or integrative therapies in addition to conventional treatment, but focused instead on a small subgroup of patients who chose alternative treatments as their initial and sole therapy. Journal of the National Cancer Institute

FDA ACTION

• Will warn of dangers of electronic nicotine delivery devices, not just tobacco products

• Approved Mavyret for Hepatitis C in adults.

• Approved the combination drug Vyxeos (daunorubicin and cytarabine) as the first treatment for certain high-risk types of acute myeloid leukemia

• Recalled Some Liquid Pharmaceutical Products due to possible contamination. The drugs and dietary supplements, made by PharmaTech LLC in Davie, Fla., include liquid stool softeners, liquid vitamin D drops and liquid multivitamins marketed for infants and children, the agency said in a news release.

• Approved the anti-cancer drug Besponsa (inotuzumab ozogamicin) to treat B-cell acute lymphoblastic leukemia (ALL)

PREVENTION

• Midlife cardiovascular risk factors may increase chances of dementia: A large, long-term study suggests that middle aged Americans who have vascular health risk factors, including diabetes, high blood pressure and smoking, have a greater chance of suffering from dementia later in life. JAMA Neurology

• Protein at all 3 Meals May Help Preserve Seniors’ Strength: Eating protein at all three daily meals, instead of just at dinner, might help seniors preserve physical strength as they age, new research suggests. The Canadian study found that protein-rich meals evenly spread throughout the day staved off muscle decline, but did not increase mobility, in older people. American Journal of Clinical Nutrition

• Increased endometrial cancer rates found in women with high levels of cadmium: Through a five-year observational study, researchers found that women with increased levels of cadmium -- a metal commonly found in foods such as kidneys, liver and shellfish as well as tobacco -- also had an increased risk of endometrial cancer. It's an observation the researchers hope could lead to new treatments or interventions to prevent the fourth most common cancer in women. PLOS One

• Lifestyle Changes Could be Key to Managing Type 2 Diabetes: A study showed that adding intensive lifestyle management to standard diabetes care (diabetes medication and usual lifestyle change advice) brought blood sugar into a nondiabetic range.  The intensive intervention worked so well that "half of the intervention group did not need glucose-lowering medications to maintain or even improve [blood sugar] control. "Patients were prescribed exercise five to six times per week for 30 to 60 minutes per session. That included both endurance and resistance training," They received a dietary program with focus on foods rich in fiber, low in saturated fats, lots of fruit and no processed food. JAMA

• Givers are happier than Takers: Generosity really is its own reward, with the brain seemingly hardwired for happiness in response to giving, new research suggests.

Scientists in Switzerland used brain scans to track activity in brain regions associated with socializing, decision-making and happiness. They found that even small acts of generosity -- or just promising to be charitable -- triggered brain changes that make people happier. Nature Communications

• Taking a Stand on Staying Mobile After 80: New research shows that a standing-exercise program is more effective for older adults than commonly used seated exercises. Among nearly 300 participants who were an average age of 80, those who took part in a standing-exercise program were able to walk faster and farther than those in a seated-exercise program, researchers reported. JAMA Internal Medicine

• Outdoor light at night linked with increased breast cancer risk in women: Women who live in areas with higher levels of outdoor light at night may be at higher risk for breast cancer than those living in areas with lower levels, according to a large long-term study. The link was stronger among women who worked night shifts. Environmental Health Perspectives

NUTRITION/SUPPLEMENTS/VITAMINS

• Moderate Drinking linked to Reduced Risk of Dementia: Moderate drinking may be associated with a reduced risk of dementia in seniors, a new study suggests. But the study authors stressed that the findings shouldn't be interpreted as a signal to drink freely. The study only found an association between some alcohol consumption and mental sharpness, not a cause-and-effect link. Researchers followed more than 1,300 adults from 1984 to 2013. They lived in a white-collar, middle- to upper-middle-class suburb in San Diego County, California. Most were white with at least some college education. Journal of Alzheimer's Disease.

• A Little Drinking Might Lengthen Your Life: Light to moderate drinking can lower your overall risk of premature death and, specifically, your odds of dying from heart disease, a new study reports. Moderate drinkers -- men who have one or two drinks a day, and women who have one drink a day -- have a 29 percent decreased risk of heart-related death and a 22 percent reduced risk of death from any cause, compared with teetotalers, the study findings showed. Journal of the American College of Cardiology

• High Cal Foods May Raise Cancer Risk: Women who eat a lot of high-calorie foods may face a slightly higher risk of obesity-related cancers -- even if they remain thin, a new study suggests. The study, of more than 92,000 U.S. women, found those who favored high-calorie, low-nutrient foods had a 10 percent higher risk of cancers linked to obesity. These include processed foods like chips, fast foods and sweets. The list of malignancies included breast, colon, ovarian, kidney and endometrial cancers. Obesity is considered one of many risk factors for those diseases. Journal of the Academy of Nutrition and Dietetics

• Walnuts activate brain region involved in appetite control: Double-blind test bolsters observational data that walnuts promote feelings of fullness. Results provide a quantitative measure for testing other compounds' ability to control appetite, including potential medications for the treatment of obesity. Beth Israel Deaconess Medical Center

TREATMENT

• Diabetes drug shows potential as disease-modifying therapy for Parkinson's disease: A drug commonly used to treat diabetes may have disease-modifying potential to treat Parkinson's disease, a new study suggests, paving the way for further research to define its efficacy and safety.  The study, published in The Lancet found that people with Parkinson's who injected themselves each week with exenatide for one year performed better in movement (motor) tests than those who injected a placebo.

• Anti ulcer drugs do not increase risk of Alzheimer’s disease: The association between proton pump inhibitors and Alzheimer's disease was studied at the University of Eastern Finland, as two previous studies from Germany reported an increased risk of dementia. However, these findings were not confirmed by the extensive Finnish study, at least not for the risk of Alzheimer's disease, which is the most common form of dementia. The results were published in American Journal of Gastroenterology.

• Researchers advise caution about recent US advice on aggressively lowering blood pressure: New research suggests the benefit of aggressively lowering blood pressure in older people, as per major US SPRINT trial, should be balanced against the increased the risk of associated falls and blackouts as otherwise it may harm rather than help.JAMA Internal Medicine

• Antidepressant use increases risk of head injuries among persons with Alzheimer's disease: Antidepressant use is associated with an increased risk of head injuries and traumatic brain injuries among persons with Alzheimer’s disease, according to a new study. Antidepressant use has previously been linked with an increased risk of falls and hip fractures, but the risk of head injuries has not been studied before. Alzheimer's Research & Therapy

• Powerful New Cholesterol Med Won't Harm Memory, Easing Concerns: Despite some early concerns, a new study suggests the powerful cholesterol drugs known as PCSK9 inhibitors may not cause memory problems or other mental symptoms. The drugs, which include evolocumab (Repatha) and alirocumab (Praluent), were approved in the United States in 2015. That came after trials showed they can dramatically slash LDL cholesterol (the "bad" kind), including in people with a genetic condition that often causes premature heart disease. NEJM

OTHER

• Independent pharmacies and online coupons help patients save money on drugs:

Consumers can get better deals by price shopping at independent pharmacies and using online coupons, study shows. However, few Americans actively comparison shop for health care, according to a separate study. Health Affairs and American Journal of Managed Care

• Video Game Playing and Gray Matter: A new study suggests -- but doesn't prove -- that certain players of action video games may lose gray matter in a part of the brain that's linked to mental illness.  On the other hand, the Canadian study suggests, other players may actually benefit from the games. The results indicate that the reported benefits of playing shooting-style video games -- such as improved attention and short-term memory -- "might come at a cost" in terms of lost brain matter in some players. Molecular Psychiatry

• Americans Taking More Prescription Drugs than Ever: A new survey finds 55 percent of Americans regularly take a prescription medicine -- and they're taking more than ever. Those who use a prescription drug take four, on average, and many also take over-the-counter drugs, vitamins and other dietary supplements, the survey done by Consumer Reports shows. But many of those pills may be unnecessary and might do more harm than good, according to a special report in the September issue of Consumer Reports magazine.

• Virtual House Calls for Speedy, Effective Parkinson’s Care: Parkinson's disease patients get as much benefit from seeing a neurologist via home video conference as from seeing a local doctor in person, a new study reports. The research included nearly 200 patients who received either care from their usual doctor or their usual care plus up to four video (virtual) visits with a neurologist they had not seen before. The virtual visits were as effective as in-person visits. In both groups, quality of life, quality of care and burden on caregivers was the same, the study found. Neurology

• Cancer Takes Financial Toll, Even With Insurance: Many cancer patients in the United States are shocked by their out-of-pocket costs for care -- with some spending one-third of their income on treatment, a new study finds. the study found, patients typically spent nearly $600 a month on their treatment. Overall, 16 percent said they were facing "high or overwhelming financial distress." Those patients were spending nearly one-third of their monthly income on cancer care. JAMA Oncology

Take a Break: Make a Butterfly Tree

Love butterflies and our season is so short in Vermont. A butterfly tree is the perfect way to extend it.

• Take some branches from a bush or tree, or use twigs that you’ve painted-or not.

• Put them in a vase.

• String some tiny lights

• Decorate with butterflies that you can easily make 

Accordion folded butterfly  

Origami butterfly  

Paper butterflies

                                                             Tissue Paper Butterflies

Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Life with Chronic Conditions: Shop Around for the Best Pharmaceutical Prices

Two new studies have recently shown that:

a) Uninsured patients or those with limited prescription drug coverage can save significant money by buying their drugs at independent pharmacies instead of big box, grocery or chain drug stores and by using discount coupons. The cash price for a commonly prescribed generic antibiotic can vary, on average $52, within a single ZIP code, according to the study published recently in the American Journal of Managed Care. Note this study was done in California

b) A separate study in the journal Health Affairs confirmed that health care price shopping is uncommon

Interestingly Consumer Reports also came out with a study that looked at pricing nationally and found that prescription drug prices can vary widely from retailer to retailer. They recommend

• Costco as they consistently had the lowest retail prices for the drugs they were checking. You don’t need to be a member to use its pharmacy, though joining can gain you more discounts.

• Support independent pharmacies

• Don’t always use your health insurance as many chain and big box stores offer hundreds of common generics at prices as low as $4 for a 30 day supply and $10 for a 90 day supply for people who pay out of pocket.

• 90-day prescription can be cheaper than 30 day.

• Look online. Only use an online retailer that clearly operates within the US and displays the “VIPPS” symbol. 

• Avoid Canadian sites as they are often fake storefronts selling low quality or counterfeit products.

• Talk to your provider about costs and ask for generics

Read more Consumer Report tips at Save Money on Meds: 9 Tips for Finding the Best Prescription Drug Prices

What you can do:

• Go to one of the online sites to do price comparisons and take advantage of coupons. Below is just a sampling of what’s on-line.

- Discount Drug Network This site allows you to shop by location. Checking this site, I found that the cheapest option was actually WalMart and the private pharmacies were much more expensive in my area.

GoodRx 

Lowest Med

• Contact your condition specific association (e.g. American Diabetes Association) as well as talk to your medical provider about cheaper alternative medications as well as coupons or other means they may be aware of to lower costs. Medical providers may have samples.

• Many manufacturers offer drugs at no cost or significantly reduced cost for those who qualify financially. Check Pharmaceutical Assistance Program 

• Check to see if your state has a States pharmaceutical assistance programs (SPAP).  Each program works  differently. Some states offer programs that can help people with certain illnesses pay for their prescription drugs. For example, many states offer HIV/AIDS drug assistance programs (ADAP) and programs for people who suffer from End-Stage Renal Disease (ESRD).

• If you qualify for Medicare, check out Save on Drug Costs

Take a Break: Prepare for the Solar Eclipse

On Aug. 21, there will be a total eclipse of the sun. While everyone in the United States will experience a partial eclipse, if you’re living in the right state, for two full minutes, the moon will block the sun. Check this website to find out how much of the eclipse you’ll be able to see and at what time.

So what factors come in to play for a solar eclipse? 

During the new moon cycle, the dark side of the moon is directly facing the earth and the moon’s orbit with the earth’s need to match. If they didn’t we’d have a solar eclipse every time there was a new moon. The moon’s orbit around earth is an oval not a circle, so that means the moon is sometimes closer to the sun. For a complete solar eclipse the moon must be closest to the earth. There are times when the moon is at it’s farthest distance from earth and an eclipse will occur leaving a “ring of fire.” Learn more about solar eclipses.

As much as you want to go out and stare at the sun, you can burn your retina doing that, so please use the various devices recommended by NASA. 

Start checking now to see where in your community there are good viewing opportunities. Many libraries have free viewing glasses, which they are distributing.

Interestingly, different cultures have differing views about an eclipse. Many American Indians view the sun and moon as cultural deities.  The Navajo believe the sun dies and is reborn. The Havasupai tell their children not to look at the moon for too long as it has powerful energy and can bring bad dreams. In fact, a solar eclipse where the sun is blocked could be viewed as a bad omen. The Hopis do not view it as taboo, instead they refer to it as one piggybacking off the other.

 Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Life with Chronic Disease: You Have Been Paid For

I happened to come across Maya Angelou’s speech to a graduating class in where she imparted the message, “you have been paid for.”

“Young men and women, it is important for you to know that you are worth it; in fact all of your lives already been paid for. It is imperative that you know that....it is wonderful to be a part of this marvelous group but each of us is always and finally and painfully alone at certain times of our lives...No matter what you do, when you are absolutely alone, go inside yourselves, I encourage you and understand that you have already been loved. And then all you have to do is prepare yourself , so that that you can go out and pay for someone who is yet to come.”

While an important message for all us, but how poignant for those with chronic conditions, where it’s all to easy to complain about the lack of  a cure, a better treatment or a vaccine to prevent it in the first place. The fact is, many chronic conditions today were once terminal diseases. Thanks to those who spent thousands upon thousands of hours “paying it forward” through research, fundraising, lobbying, years of medical school, continuing education and more, because they felt your life and all those with a specific condition, are “worth it.” As Angelou put it, “You’ve been paid for by people who never even saw your face.” That’s quite a gift.

There is a circle of life. And there are circles of love. Circles of sacrifice. No beginning, no end.

We are here because somebody loved us.
We are here becomes somebody sacrificed for us.
We are here because somebody paid for us.

Pay it forward. Omid Safi

You can “pay it forward” to help others with your condition by sharing your data, volunteering with your condition specific organization, raising funds for research etc. For specific tips, check out The Importance of Social Capital for those Affected by Chronic Conditions.

2017 Take a Break: August Holiday Gifts to Start Now-Jars

Once again it’s time to take advantage of the lazy hazy days of summer to make some gifts in August that you can put away for holiday giving, when you may have a lot less time. At the end of this post are previous years ideas.

This year focus is gifts in a jar.

Step 1 Collect jars with lids: Some foods now come in Mason jars-Green Mountain Salsa and some pasta sauces. Thrift stores can be another source of cheap Mason jars, or because it’s canning season, many stores are stocked with them.

Step 2 Decorate the jars. Somethings are best added just before you give them as a gift, such as candies, teas, bath bombs  etc. Now’s the time to design the jar and have it all set so you can just add the item and be done. You can use chalkboard paint- mix unsanded grout with paint (acryclic’s are fine). You can paint the lids make gift and instruction tags etc. Some last minute items to add to the jar: Sugar Scrub (mix coconut oil, sugar, a little peppermint extract); cookie mix  Lavender Bath Salts

Canning: It’s harvest season, so a perfect time to make pasta sauce, preserves, pickles or whatever you think people might enjoy. While a jar of jelly is an appreciate gift, add a loaf of bread, or a special jam knife.

Sewing Kit: Excellent idea for college students and those living away from home, or a “to go” item for a crafter. 

Dr. Seuss Gift in a Jar for Teachers  Very cool project

Soap Dispenser: You can easily turn a Mason Jar into a soap dispenser for kitchen or bathroom use by cutting a hole in the top and adding a soap pump. If you go with a foaming pump, be sure to include directions on how to replace the soap-1/4 liquid soap or detergent to ¾ cup of water.

Artist Kit: Use a wide mouth jar and put in colored pencils and good quality markers. Because some of the items will be longer than the jar, replace the insert of a Mason or Ball jar with wire mesh (available from a hardware store). Cut the mesh to fit inside the bands.

Keep Warm Kit: Add a pair of warm socks, a packet or two of coco; hand and foot warmers; stretchy gloves that fold up easily (can get these at the Dollar Store)

Previous Years  August Holiday Gifts to Start Now

• 2010: Candles; Eyeglass case and bookmarks; fabric flower brooch 

• 2011: Environmentally friendly cleaning products; Cookie Cutter Fudge; Balloon Candle Holders; Popsicle Bracelets; Frame a game Board

• 2012: Make a variety of items using the sun including sun stencils and art work 

• 2013: From fruitcakes to fabric covered canvas 

• 2014 Edition: Infinity scarf,  knife block or stripe, fire starters, flavored syrups, activity books  

• 2015 Presents for the gardener in your life

• 2016 Bowls